CCRN Neonatal – Critical Care Nursing Neonatal Exam Review

The CCRN Neonatal is a certification exam created by the American Association of Critical-Care Nurses Certification Corporation that is very similar to the CCRN Pediatric Exam except that the CCRN Neonatal Exam is used to determine whether or not an individual has the knowledge necessary to be an effective critical care nurse specifically for infants.

The CCRN Neonatal Exam does not register an individual as a registered nurse and is usually not required for an individual to work in a neonatal critical care unit. However, it is an indication that an individual has an advanced knowledge of critical care procedures related to neonatal care and allows the individual to use the CCRN letters after his or her licensing credentials.

The CCRN Neonatal Exam consists of 150 multiple-choice questions, 125 of which are scored and 25 that are not scored, that covers information related to the following areas:

  • Cardiovascular (10%)
  • Endocrine (4%)
  • Gastrointestinal (7%)
  • Hematology and Immunology (4%)
  • Multisystem (11%)
  • Neurology (6%)
  • Pulmonary (36%)
  • Renal (2%)
  • Advocacy and Moral Agency (2%)
  • Caring Practices (4%)
  • Collaboration (4%)
  • Clinical Inquiry (2%)
  • Facilitation of Learning (4%)
  • Handling Diversity (2%)
  • Systems Thinking (2%)

Individuals taking any CCRN exam will have three hours to complete the exam. The CCRN Neonatal Exam is scored in the same manner as the CCRN Pediatric Exam and the individual will receive a final grade of pass or fail depending upon whether or not the individual answers enough questions correctly to reach the passing threshold. The number of correct responses required to pass the CCRN Neonatal Exam is usually 70% or 88 questions, but varies depending upon exactly which exam questions an individual receives.

For an individual to take the CCRN Neonatal Exam, the individual must be a registered nurse without any restrictions on his or her license of any kind. The candidate must have also worked in a critical care environment handling prenatal care for at least 1,750 hours of which 875 hours have been completed in the year prior to the candidate’s application.

Potential candidates can register for the CCRN Neonatal Exam on the AACN Certification Corporation website and can choose to take the CCRN test in either a computerized form administered by AMP or a written form administered by the NTI. The registration fee for the CCRN Neonatal Exam is $220 for AACN members and $325 for nonmembers.

CCRN Practice Tests

Free CCRN Neonatal Practice Test Questions

1. If a newborn’s stroke volume is about 5 mL, what is the average pulse required to ensure adequate cardiac output?

A. 100 bpm.
B. 145 bpm.
C. 180 bpm.
D. 195 bpm.

2. A neonate has a differential diagnosis of congenital muscular dystrophy (CMD) (laminin alpha-2 deficiency) and exhibits hypotonia at birth with poor feeding and mild respiratory distress. Which tests are necessary to establish the diagnosis?

A. Creatinine kinase.
B. Electromyogram, nerve conduction studies, and muscle biopsy.
C. Muscle biopsy only.
D. MRI only.

3. The nurse is inserting a PICC for an infant who requires extended IV therapy because of very low birth weight. During the procedure, the infant must be monitored for which of the following?

A. Tachycardia and tachypnea.
B. Bradycardia and hypoxia.
C. Atrial fibrillation.
D. Blood pressure.

4. A mixed venous oxygen saturation (SvO2) level of less than 60% can indicate which of the following?

A. Increased hemoglobin, PaO2, and/or cardiac output.
B. Decreased hemoglobin, PaO2, and/or cardiac output.
C. Decreased oxygen consumption.
D. Sepsis.

5. A 21-day-old neonate develops green-bronze jaundice, dark urine, claycolored stools, abdominal distention with distended abdominal veins, and hepatosplenomegaly with firm liver. Liver biopsy and test shows extrahepatic biliary atresia, and a hepatoportoenterostomy (Kasai procedure) is done to create a conduit between the liver and small intestine. Which added vitamin(s) or minerals should the baby receive postoperatively?

A. Water-soluble vitamins (B-complex, C).
B. Fat-soluble vitamins (A, D, E, K).
C. Calcium.
D. Potassium.


Answers and Explanations

1. B

A newborn requires a cardiac output of about 800 mL/min, but the stroke volume is usually only about 5 mL because of the small size, so a heart rate of about 145 bpm is needed to ensure adequate output. A period of apnea is usually followed by decreased heart rate and oxygen saturation. Heart rates will vary depending on whether the neonate is awake, sleeping, or active.
< 1 week: At rest, 100 to 180; asleep, 80 to 160; active/sick, 220 or lower.
1 to 2 weeks: At rest, 100 to 220; asleep, 80 to 200; active/sick, 220 or lower.

2. B

Tests to confirm diagnosis of congenital muscular dystrophy (laminin alpha-2 deficiency), the most common type (40%), include electromyogram and nerve conduction studies to both confirm that the symptoms relate to myopathy and to rule out other disorders. These tests are followed by a muscle biopsy to confirm the diagnosis. Changes in the periventricular white matter are usually not evident on MRI until after 6 months. Creatinine kinase is typically elevated with CMD but this cannot establish a diagnosis.

3. B

A neonate receiving a PICC should be monitored for bradycardia and hypoxia during the procedure. PICCs are contraindicated if IV therapy is less than 6 days, if vessels are inadequate, or if abnormalities of the thoracic area or extremities may impede insertion. If the infant has active bacteremia or sepsis, the PICC line should be inserted only after administration of antibiotics for 24 to 48 hours. Caution must be exercised with coagulation disorders or concurrent treatment with high frequency ventilation. PICCs should not be used for blood products or to obtain blood specimens.

4. B

A mixed venous oxygen saturation (SvO2) level less than 60% indicates a decrease in delivery of oxygen because of decreased hemoglobin, PaO2, and/or cardiac output OR increased consumption of oxygen (VO2), which can occur with fever or seizures. Increased SvO2 level greater than 80% usually indicates the presence of sepsis.

5. B

As part of postoperative management of surgery to repair extrahepatic biliary atresia, the neonate should receive fat-soluble vitamins (A, D, E, K) because these nutrients were not absorbed before surgical repair. Biliary atresia prevents bile from leaving the liver, causing the liver to become inflamed and scarred. With extrahepatic biliary atresia, the ducts outside of the liver are damaged, so surgical repair may be successful if liver is not severely compromised. Intrahepatic and severe extrahepatic biliary atresia require liver transplant.